Rheumatoid arthritis or RA is an auto immune condition that affects the joints, leading to stiffness and painful inflammation in the body. However, like most of the conditions linked with inflammation and blood circulation, it also has a strong link with the heart and has been pointed out as a serious cardiac risk factor.
Multiple rheumatologists and cardiologists pointed out to Happiest Health that RA could also adversely affect the heart’s blood-vessel walls, which could even ultimately result in a heart attack.
In those affected by RA, the immune system mistakenly attacks the healthy cells and tissues of the joint leading to pain and inflammation.
People with this condition are more susceptible to heart attacks also because of lifestyle-related risk factors such as obesity, smoking and an undesirable lipid profile. Sometimes RA could also be genetic and affect people who have a family history of the condition.
Link between rheumatoid arthritis and heart health
Bengaluru-based Dr Chethana D, consultant, rheumatology, Aster CMI Hospital, says that RA affects the heart by causing pericarditis — which is the inflammation of the lining of the heart (just like the inflammation in the joints) — but if it is more severe, it causes pericardial effusion, which is fluid collection on the lining of the heart that can compress and hamper the functioning of the heart.
“A widespread chronic systematic inflammation like RA poses an increased risk of coronary artery disease in people with RA as compared to the general population,” says Dr Mukesh Goel, cardio-thoracic and vascular surgeon and senior consultant at Indraprastha Apollo Hospital, New Delhi.
The inflammation slowly narrows the arteries thereby affecting blood circulation, which could lead to a shortage in the supply of oxygenated blood to the organs and even result in a heart attack or stroke.
According to an article published in the American Journal of Medicine, a retrospective study on people in the early development stage of RA in Rochester, Minnesota, found that patients with the condition were at increased risk of cardiovascular death, ischemic heart disease, and heart failure compared with age- and sex-matched community controls. Their coronary artery tissue was examined and increased evidence of inflammation, apart from increased proportion of unstable plaques, was observed.
Rheumatoid arthritis needs strict cholesterol management
Experts say that people affected with RA need to monitor their lipids as well as sugar levels apart from blood pressure, just like someone affected with diabetes or any cardiovascular condition. However, some like Dr Goel says that just because an individual has RA doesn’t mean that they would eventually end up with cardiac complications.
Dr Chethana says that early detection of RA and timely care and intervention are crucial in avoiding any adverse cardiac complications from pericarditis. “It is important to watch out for ischemic heart disease (cause by reduced blood supply to the heart), which calls for regular lipid tests, sugar and BP tests in people with RA,” she says.
Gurgaon-based entrepreneur Monalisa Rao, who used to be a flight attendant earlier, was diagnosed with a painful and nearly crippling RA when she was 35. Her doctor specifically sensitised her about the possible inflammation-related effects on different organs, including the heart.
“I was asked to immediately go for steroids and was informed about the risk of physical deformities and heart inflammation which could lead to interruption of blood flow and blockages if I didn’t not control my RA,” says Rao, who is now 40.
Rao didn’t have a high cholesterol but was asked to always keep her lipid profile within the expected range. Also aware of the adverse effects of depending on steroids, she first decided to make big changes to her diet. She immediately switched to a gluten-free diet comprising fresh fruits and vegetables.
“I started having brown or black rice in moderation,” she says. Rao also quit dairy, which she feels has helped her immensely. “I believe because of my diet and lifestyle change all my markers are always within the desirable limits, including the protein and calcium markers which surprised my doctors,” she says. “I have been advised to continue with whatever I have been doing.”
So, Rao has successfully managed her condition sans medication (steroids), with diet control and a health-centric lifestyle which includes yoga and breathing exercises.
Unlike Rao, many people affected with RA are oblivious to the cardiac risk associated with the condition. Dr Chethana says it becomes the physician’s job to ensure that the person affected is made aware of the risk factor associated with the condition so that they exercise timely caution.
She feels people with RA are at more than 50 per cent risk of heart attack than general population. “A person with a prolonged and uncontrolled rheumatoid with high inflammation is at a higher risk of having a heart attack than somebody who doesn’t have RA,” says Dr Chethana.
The way to find out how alarming the situation is by physical symptoms that are indicators of a heart attack and blood works and tests like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein), both of which are the biomarkers of inflammation. “The higher the CRP value, the higher the skin inflammation, the greater is the cardiovascular risk,” says Dr Chethana.
Lifestyle check for rheumatoid arthritis
Dr Goel says that apart from going for blood tests, other traditional risk factors for heart condition like smoking, drinking and being obese also need to be controlled. “It is important to maintain appropriate weight and diet apart from managing RA symptoms,” he says. “It has been observed that people with RA tend to have higher frequency levels of protein and altered lipid profile compared to the general population.”
Though high HDL is considered to be good cholesterol, it has been observed that in people with RA total cholesterol — including HDL and LDL cholesterol — is low. “While low LDL should ideally be protective, these people also have a low level of HDL, which makes them susceptible to heart attacks,” says Dr Goel.
Dr Goel says that is because in this condition the function of HDL is found to get altered. “Instead of antiatherogenic or plaque preventive effect, it becomes proatherogenic, which means these people are more likely to develop the calcium- and cholesterol-rich plaques in their blood vessels.”
Rheumatoid arthritis and lifestyle matters
Dr Chethana says often people affected with RA get accustomed to a sedentary lifestyle because of their aches and pains, especially if their arthritis is uncontrolled. “That’s when they gain weight, and if they gain weight, it leads to other metabolic issues which can eventually lead to cardiovascular disease,” she says.
Dr Goel explains people with RA who are smokers are the most vulnerable to heart disease risk factor because smoking is known to cause oxidative stress, raise blood pressure and reduce the good cholesterol, which can lead to plaque formation.
“These people have been observed to have low muscle mass and high visceral fat which can cause insulin resistance, high blood pressure and metabolic syndrome which are the contributing factors for CAD,” says Dr Goel.
Occasionally, people with RA may have painful flare-ups and that is when doctors need to swiftly start monitoring their blood pressure, sugar levels and cholesterol levels to rule out any cardiac event. “A physician’s role here is to ensure that their lipid ratios are reversed and balanced,” says Dr Goel.
For people with severe flare-ups and pain, steroids are administered as painkillers. But experts warn that steroids too can have an adverse effect on the body.
“Sometimes a heart condition can go undetected at its early stage in people who take steroids for a long time and don’t visit the physician for a follow-up, because steroids supress their pain and swelling,” says Dr Goel.
Dr Goel says taking steroids itself increases the risk of cardiovascular disease and people taking them need to be alert and regular with their full-body check-ups. Someone who has RA and heart disease is advised to go for a check-up every three to six months as advised by the physician. “All these factors should be looked for and treated because these go long way in prevention of heart disease,” says Dr Goel.